Onconephrology

Onconephrology (from the Ancient Greek onkos (ὄγκος) meaning bulk, mass, or tumor, nephros (νεφρός) meaning kidney, and the suffix -logy (-λογία), meaning 'study of') is a burgeoning new specialty in nephrology that deals with the study of kidney diseases in cancer patients. Onconephrology (from the Ancient Greek onkos (ὄγκος) meaning bulk, mass, or tumor, nephros (νεφρός) meaning kidney, and the suffix -logy (-λογία), meaning 'study of') is a burgeoning new specialty in nephrology that deals with the study of kidney diseases in cancer patients. A nephrologist who takes care of patients with cancer is called an Onconephrologist. This branch of nephrology encompasses both the hematologic and oncology based cancers and their treatment related complications that deal with the kidney. Unlike general nephrology, there are several aspects of onconephrology that are unique. Kidney failure from break down of cancer cells, usually after chemotherapy, is unique to onconephrology. The Syndrome of Inappropriate Anti Diuretic Hormone (SIADH) that causes low serum sodium concentration and first described in lung cancer patients is common in cancer patients. Kidney diseases that are unique to bone marrow transplant (aka Stem Cell Transplant or SCT) are frequently seen in cancer patients. Fluid, electrolytes and acid base disturbances are much more common and often severe in cancer patients, especially in those who receive chemotherapy. Several chemotherapeutic agents – for example cisplatin – are associated with acute and chronic kidney injuries. Newer agents such as anti Vascular Endothelial Growth Factor (anti VEGF) are also associated with similar injuries, as well as proteinuria, hypertension and thrombotic microangiopathy. The most common form of kidney disease in cancer patients is acute kidney injury (AKI) which can usually be due to volume depletion from vomiting and diarrhea that occur following chemotherapy or occasionally due to kidney toxicities of chemotherapeutic agents. Less frequently AKI can occur due to obstruction to urine flow from tumor or lymph node enlargement. Also, cancer cells by infiltrating the kidney or myeloma proteins by precipitating with in the tubules of the kidney can cause kidney injury.